Come visit us at www.rondentist.com

Come visit us at www.rondentist.com

Wednesday, March 28, 2012

My Tooth Hurts But My Dentist Can't Find the Problem- Good Chance It is a Cracked Tooth

A patient comes into the office and says that he is having discomfort on one side. He has hasn't eaten on that side for months if not years.  The culprit tooth has a small filling in it or no filling at all.  In the x-ray the tooth looks perfectly normal.

I am most definetly starting to think CRACKED TOOTH!!

I place pressure on each cusp separately.  On one of the cusps, as the patient opens from pressing, then the tooth starts to hurt.  Yes it is a cracked tooth.

Can you see it on the x-ray?  No you can't since the tooth is fractured and not broken.  When it is fractured the two sides are close together and an X-ray will not pick up the fracture.

Why is it hurting if the sides are still together?  This is because, as you bite down on the tooth, the sides of the tooth are flexing.  At that point fluid moves in and out of the tooth causing pain.

So how do you fix it?  This is the easy or hard part.  It all depends where and how far down the root the tooth is fractured.  To fix this problem you need a crown on the tooth.  By shaving the tooth down and then covering it with a crown (or cap) all the forces of biting will be directed internally and the fractured parts will be held together thus stopping the pain.  To test this, we place a temporary crown on the tooth first.  If the symptoms disappear then we can go ahead with the permanent crown and have reasonable confidence in the outcome.  If the fracture goes further down the root and beyond the crown then the symptoms may persist.  We may need to do a root canal and the symptoms may then disappear.  But overall the prognosis is now guarded.  When the crown does not encompass the entire fracture the tooth may still be flexing and the long term prognosis is questionable.

Does this happen a lot?  Actually it happens quite a bit, even teeth that have never had a filling in them get fractures.  This is called wear and tear.  If you never use your teeth this will never happen to you.  Since most people use their teeth quite a bit and of course many of us also grind our teeth which makes this worse, quite a few of us will experience this throughout our lifetimes.

If you have any questions, you can always send me a note.

All the best

Dr. Ron Barzilay
Hamilton Ontario

Don't forget, you can become a follower of this blog!

19 comments:

  1. Some great blogs here! Dentistry blogs are very important for any dental business. You can really learn a lot from them. Thanks

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  2. I have this problem when I bite down with my right side it hurts , its just one top tooth and I had just went to fill a cavity right next to it about 2 weeks before the pain came. I haven't ate on that side for about a week going on to two and I don't know what to do??

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  3. HI Kathleen,

    First of all call your dentist and have them see you.
    If you had a filling done in the same area a couple of weeks before the pain started it may be simply that the filling that was done may be a little bit high (even if you don't feel that it is) and needs to be adjusted. It may also have been a deep filling close to the nerve and there could be a problem with the nerve. Those are the things that come to mind first since your pain started in close proximity to the time a filling was placed. Of course it may also be another tooth.
    Get back in touch with your dentist ASAP as this will not clear up on its own.

    Let me know what happenned.

    All the best

    Dr. Ron

    Ps. Become a follower of the blog as I touch on these situations which we see from time to time.

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    1. This comment has been removed by the author.

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    2. I had a filling and soon after I have pain every now and then. I went back a few weeks after and they said they couldn't find anything wrong with the tooth. I still get pain every now and then. What should I do?

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    3. It doesn't hurt to touch it or eat with it. It may hurt while I am eating, but it doesn't seem to be the cause.

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    4. HI Willard,
      Without examining you I can't know for sure but here are the range of possibilities.
      1. The filling that was done may be high and may just need an adjustment of the bite. Did they check it with bite paper? Even if your bite feels fine it may still be high. This type of situation will cause pain on chewing.
      2. The filling may have been very deep and close to the nerve. There may be nerve damage and the tooth may need a rootcanal. This may be more likely if the pain is lingering or if it wakes you in the middle of the night and is quite severe and intense.
      3. There may have been a problem in the placement technique. This is rare but sometimes it happens and you get pain on chewing. In this case redoing the filling will solve the problem.
      4. I don't know why the original filling was done. That would perhaps give me a clue as to the problem here.
      You notice I haven't mentioned tooth fracture. This is something that is sensitive when chewing but if it wasn't sensitive before the filling, I doubt it is a fracture.
      Sorry I can't be more accurate but without seeing and checking it I can't know for sure.
      Of course, if the situation is not improving then go back to your dentist and have them check further. Let me know how it works out.
      If you have any more questions just send them.
      All the best and good luck
      Dr. Ron Barzilay
      www.rondentist.com

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  4. MY front tooth is broken into half.. then when i check the other half part left, i found a crack that split my front tooth diagonally.. i dont know how far the crack is, but ithink its quite deep inside all the way to the root.. but the point is, can it be saved or must get implant?

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  5. Hi Richard,
    To tell you wether I think it could be saved or wether it needs an implant I would need you to send me a picture and an x-ray. Even then I would still need to physicaly examine the tooth to give you a diagnosis. From your description I really don't know what is going on. Is it decayed? How deep does the decay go? How deep does the fracture go?
    What does your dentist say?
    If you don't have a dentist then you need to find one ASAP to get this looked at.

    All the Best

    Dr. Ron Barzilay

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  6. Fortunately, my dentist warned me about this case. I used to have a mannerism of grinding and clenching my teeth. Plus, I liked eating ice to fill in that manner. He said that if I don’t discipline myself from doing these, I’ll end up with cracked teeth. However, being masterful in his profession, he knew I wouldn’t be able to easily give up the manner. So, he suggested wearing a mouthguard. After a few weeks of wearing it, I stopped my grinding and clenching. I don’t eat ice cubes any longer, as well.

    Jerri Franceschi

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    1. Hi Jerri,
      Cracked teeth as a result of grinding happens quite frequently. Your dentist did the right thing by recommending a nightguard for you.
      Thank you for relaying your experience.
      All the best
      Dr. Ron Barzilay

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  7. I also had the same experience as your patient, but mine was severe. I could barely touch my meal, and the pain was head-splitting. So I decided to an appointment with my dentist. What he told me is that my tooth was broken and was infected. And the best option he offered was to perform an extraction as more serious complication may arise.

    Kaley Baum

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  8. Hi Kaley,
    Sorry to hear that you lost the tooth but usually when the pain is so severe the outcome may not be great.
    I hope you don't run into similar problems in the futrue.
    All the best
    Dr. Ron Barzilay

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  9. Since I was young, I always absentmindedly bite on my pencil. When I started experiencing tooth sensitivity and sharp pain, I consulted with my dentist and, voila! He said that I got a cracked tooth due to bad chewing habit, which got me to force myself to stop my sordid mannerism.

    Jamar Schaffer

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  10. I believe I cracked a molar while eating (loud crack, at the tooth site, twice now - second time worse than first). My dentist insisted it was my wisdom tooth, which has been half-in for years, but has never caused me any problems (although he's been bugging me to get it out for years now). I trusted his diagnosis, although in my gut, I knew it wasn't right. He never could explain the LOUD cracks (fyi, NOT in my jaw). Now wisdom tooth is gone, and extraction site healed, and I still can't bite down on that side of my mouth without severe pain. My NEW dentist agrees that although the tooth is a virgin, and x-rays show nothing unusual, it's probably a crack. He recommends a night mouthguard (as I do clench), and wait until the tooth cracks further. That will not happen if I can help it, as it is very painful and I won't chew on that side. My question to you...should I be okay with just trying the mouthguard and hope the pain subsides (and just live with not being able to eat on that side)? Isn't there something that can be done to pinpoint the crack, or alleviate the problem?? A crown? Pull the tooth? I need the pain to stop. Unfortunately, lacking dental insurance, and on a tight budget, I also need that to be considered when remedying the situation. Can you help me ask my dentist the right questions, please??

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    1. Dear mypoeticlicense,
      A mouthguard is only good while you wear it and you obviously will not be wearing it while you eat so that will rules out a mouthguard as being of any use in this situation. I agree with you that there is no point in waiting for the tooth to break because at that point, depending on how it breaks, the tooth may be fixable or, if not, then may have to be extracted. Also it may take months to years for it to actually break and you don't want to have to wait with the discomfort you are having right now. So how do you find the problem? Ask your dentist if he has a frac finder or tooth slooth. This is a very inexpensive plastic instrument that the dentist places on the cusps of the tooth and he asks you to close down with gentle pressure from the opposing arch. The sign of a fracture is that as you open you will feel the pain. The dentist does this on each cusp of the posterior teeth and checks for the response. The idea is that as you bite down on food the tooth flexes inwards, as you release(open) that is when you feel the pain as the tooth flexes back out. This signal that this is the tooth. It is a pretty good indicator along with other criteria that your dentist is checking for. Once you have localized the tooth then the treatment is to place a temporary crown on the tooth. If your pain goes away with the temporary crown then you can go ahead with the permanent crown. If the pain does not subside with the temp crown then you may be looking at a root canal. Please bear in mind that most times we don't know how far down these fractures go so the prognosis is always guarded (even with a rootcanal) although I find that my actual success rate is pretty high but every case must stand or fall on it's own criteria.
      Oh yes, the reason for the crown is that if there is a fracture then by placing a crown, all forces are directed inwards holding the different parts of the tooth together and not allowing the tooth to flex.
      Regarding your financial situation, that is between you and your dentist. I really can't give you any advice there except to tell you that cost wise if it is a fracture then you are looking at least a crown on that tooth or an extraction. I hope this helps you but bear in mind that you need to discuss this with your dentist as this advice is not a diagnosis and only that can be done by your dentist. If he can't help you perhaps try an endodontist.
      I hope this helps you.
      Let me know what happens. I am inerested as perhaps I will turn this into another blog subject.
      All the best
      Dr. Ron Barzilay
      Ps I liked the poetry

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    2. Thank you for your thoughtful assessment, Dr. Barzilay. I actually made an emergency trip to my new dentist since my posting, as I was in extreme pain. I nearly begged him to just extract the tooth that we identified as the problem (when he "percussed" it - not sure how right I am with that term, but "hit it gently with a small hammer-like tool" we could nail down the offender). He refused to remove the tooth without being able to find any crack. Instead he filed a high point off of the problem tooth to better my bite (I now know, my upper 2nd pre-molar). Although that seemed to help when I pressed my teeth together, four days later now and I am still having issues chewing on that side. I also have a new sensation of something stuck between the particular tooth and it's neighbor. Playing around with the tooth (ever-so-gently) with my finger, I now believe the inner part of the tooth is separated slightly from the cheek side (it even feels slightly wiggly when pressed with my tongue). With only internet research under my belt, and my layman's diagnosis (which I realize is not much), I'm wondering if it's a vertical crack. Regardless, my dentist said he would only remove the tooth for me if I went to his suggested endodontist and a crack could be located. So, as I'm pretty uncomfortable tonight, tomorrow a call will be made to the endodontist. I'm really pulling for the verdict of pulling, to get this over with once and for all! We shall see - now onward to maybe pen a poem about some teeth...

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    3. If you can feel something moving, I think you may have moved on to the next level where the tooth is actually cracked (not just a fracture). As it moves in the gums it will be very uncomfortable. If it has cracked then the treatment is to remove the fractured part and see how far down the root the tooth has fractured. There is a good chance that it will have to come out. If it comes to that then you have to start thinking of an implant instead. By the way, if you can't get into the endodontist quickly call your dentist back up because he will see the fracture and know if the tooth is worth saving. Discuss with him implants and ridge preservation (making sure there is enough bone for implants after the extraction). Let me know how it goes. I bet there is a poem coming out of this!

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  11. Update: Went to an endodontist this morning. Within half a minute of him visually looking at the problem tooth, he said there was a vertical crack and the tooth needed to be extracted. What a relief to finally be heard and validated, nevermind an end to the pain in sight! Two hours later I was back at the same surgeon's office who just removed my wisdom tooth. The cracked tooth is out, and I am giddy with the anticipation of getting back to normal. I am not filling in that gap, as my teeth are small, as is my mouth; and my wallet is beyond empty. It has now cost me a little over $1000 to determine that "the patient was right" in the first place. Not to dismiss the four dentists I have seen in the past three weeks, as I completely understand that dentistry is not an exact science. BUT, when certain symptoms are dismissed in trying to locate the issue, maybe those symptoms should be considered (i.e. loud crack at tooth #4 does NOT indicate nerve damage created by wisdom tooth). So, hopefully I will never need to post on your board again, Dr. Barzilay! Huge thanks for giving me the forum in which to vent and the wise listening ear.

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